Mary Rudolf

The impact of HENRY on parenting and family lifestyle: A national service evaluation of a preschool obesity prevention programme

OBJECTIVESnOne in five children in England are overweight/obese at school entry. Tackling obesity is therefore a priority. Right from the Start with HENRY is a widely-commissioned programme delivered by trained facilitators to small groups of parents over eight weekly sessions. It is designed to provide parents of infants and preschool children with the skills, knowledge and confidence required for a healthier family lifestyle. The aim of this work was to investigate programme impact using data collected routinely for quality control purposes.nnnSTUDY DESIGNnAnalysis of routinely collected pre-post data from programmes delivered in the UK from January 2012 to February 2014.nnnMETHODSnData were analysed from 144 programmes, including questionnaires relating to parenting, family eating behaviours, dietary intake, and physical activity/screen time.nnnRESULTSnOver 24 months, 1100 parents attended programmes running in 86 locations. 788 (72%) completed >5 sessions of whom 624 (79%) provided baseline and completion questionnaires. Parents reported increases in healthiness of family lifestyle, parenting attributes, and emotional wellbeing following attendance (all Pxa0<xa0.001). Both parents and children were reported to have increased their daily fruit/vegetable consumption, and reduced their consumption of high fat/sugar foods (both Pxa0<xa0.001). There were also positive changes in eating behaviours, physical activity (Pxa0<xa0.001) and childrens screen time (Pxa0<xa0.001).nnnCONCLUSIONSnSignificant changes were reported in all domains similar to those reported in a previous, smaller study in locations selected for experience and quality. The HENRY approach appears to have a beneficial impact even when delivered at scale in non-selected locations. Such changes, if maintained, may serve to protect against later obesity.

How can medical schools contribute to bringing about health equity

The role of medical schools is in a process of change. The World Health Organization has declared that they can no longer be ivory towers whose primary focus is the production of specialist physicians and cutting edge laboratory research. They must also be socially accountable and direct their activities towards meeting the priority health concerns of the areas they serve. The agenda must be set in partnership with stakeholders including governments, health care organisations and the public.The concept of social accountability has particular resonance for the Bar Ilan Faculty of Medicine in the Galilee, Israel’s newest medical school, which was established with a purpose of reducing health inequities in the Region. As a way of exploring and understanding the issues, discussions were held with international experts in the field who visited the Galilee. A symposium involving representatives from other medical schools in Israel was also held to extend the discourse. Deliberations that took place are reported here.The meaning of social accountability was discussed, and how it could be achieved. Three forms of action were the principal foci – augmentation of the medical curriculum, direct action through community engagement and political advocacy. A platform was set for taking the social accountability agenda forward, with the hope that it will impact on health inequalities in Israel and contribute to discussions elsewhere.

What impact does community service learning have on medical students' appreciation of population health?

OBJECTIVESnThe Bar Ilan Faculty of Medicine places public health as a priority in its medical curriculum, emphasizing its importance by strategically placing the required course as first on entry into medical school. Students are introduced to the importance of population health and community engagement through participatory community learning experiences. This study aims to examine how participatory community teaching methods impact students understanding and attitudes towards community health.nnnSTUDY DESIGNnMixed quantitative and qualitative design.nnnMETHODSn75 first year students completed the required public health course utilizing participatory community methods, including community visits, Team Based Learning, an ethnic forum, and lifestyle medicine. Evaluation comprised skills assessment through project work, analysis of reflective notes and comparison of assessment scores with students in the previous year who experienced a formal lecture-only based curriculum.nnnRESULTSnStudents acquired public health skills, including conducting a needs assessment, searching for research evidence and designing an evaluation framework. Reflective notes revealed in-depth understanding not only of course aims, but an appreciation of the social determinants of health and the local community. Test marks indicated public health knowledge reached a comparable standard (83xa0±xa07.3) to the previous year (85xa0±xa09.3; Pxa0=xa00.431).nnnCONCLUSIONSnParticipatory community learning equips students with public health skills, knowledge, and enhanced understanding of communities. It offers a way to effectively teach public health, while emphasizing the extended role and societal responsibilities of doctors.

A qualitative study of enablers and barriers influencing the incorporation of social accountability values into organisational culture: a perspective from two medical schools.

BackgroundDefinitions of social accountability describe the obligation of medical schools to direct education, research and service activities towards addressing the priority health concerns of the population they serve. While such statements give some direction as to how the goal might be reached, it does not identify what factors might facilitate or hinder its achievement. This study set out to identify and explore enablers and barriers influencing the incorporation of social accountability values into medical schools.MethodsSemi structured interviews of fourteen senior staff in Bar Ilan and Leeds medical schools were undertaken following a literature review. Participants were recruited by purposive sampling in order to identify factors perceived to play a part in the workings of each institution.ResultsAcademic prestige was seen as a key barrier that was dependent on research priorities and student selection. The role of champions was considered to be vital to tackle staff perceptions and facilitate progress. Including practical community experience for students was felt to be a relevant way in which the curriculum could be designed through engagement with local partners.ConclusionsSuccessful adoption of social accountability values requires addressing concerns around potential negative impacts on academic prestige and standards. Identifying and supporting credible social accountability champions to disseminate the values throughout research and education departments in medical and other faculties is also necessary, including mapping onto existing work streams and research agendas. Demonstrating the contribution the institution can make to local health improvement and regional development by a consideration of its economic footprint may also be valuable.

Trends in Fetal Growth Between 2000 to 2014 in Singleton Live Births from Israel

Trends in birthweight and abnormal fetal growth, namely term low birthweight (LBW), macrosomia, small-for-gestational age (SGA) and large-for-gestational age (LGA), are important indicators of changes in the health of populations. We performed this epidemiological study to evaluate these trends among 2,039,415 singleton live births from Israel over a period of 15 years. Birth certificate data was obtained from the Ministry of Health. Multivariable linear and logistic regression models were used to evaluate crude and adjusted estimates compared to the baseline of 2000 and polynomial trends. During the study period we observed a significant decrease in the rates of infants born SGA and LGA (10.7% to 9.2%, 10.2% to 9.6% respectively). After adjustment, based on the imputed data set, term mean birthweight increased by 6.0 grams (95% CI: 2.9, 9.1), and term LBW odds decreased by 19% in 2014 compared to 2000 (adj ORs: 0.81; 95% CI: 0.77, 0.85). Significant decreases were also observed for adjusted SGA, LGA and macrosomia rates. The decrease in abnormal fetal growth rates were not entirely explained by changes in sociodemographic characteristics or gestational age and may imply real improvement in child intrauterine growth in Israel during the last 15 years, especially in the Jewish population.

Can non-clinical community placements enhance medical students' understanding of the social determinants of ill health?

OBJECTIVESnTeaching the social determinants of health using classroom methods and medical settings is not effectual, yet few institutions require students to undertake placements in non-clinical settings. We sought to understand through qualitative investigation how non-clinical community placements contributed to students understanding of health disparities.nnnSTUDY DESIGNnQualitative methods.nnnMETHODSnSemistructured interviews with eight purposively selected students and a focus group were conducted by an independent, non-medical and non-religiously affiliated researcher. A thematic analysis elicited key themes and findings.nnnRESULTSnOn analysis, students valued the placements, reporting a greater understanding of and empathy for the needs of people from marginalised socio-economic, cultural and ethnic groups. Some believed this was better gained in non-clinical settings where doctor-patient barriers were absent.nnnCONCLUSIONSnNon-clinical community placements may provide a special opportunity to teach health determinants and cultural competence to medical students.

What Can Be Learned from Health-Related Tensions and Disparities in Ultra-Orthodox Jewish Families?

Promoting healthy lifestyle from early childhood is a key objective in public health, yet health behaviors are often culturally driven, especially in closed-religious communities. This study aims to reveal key cultural-religious aspects of attitudes and behaviors regarding lifestyle in one such closed community—the ultra-orthodox Jewish community. In-depth interviews were conducted with 20 participants: religious leaders, educational figures, psycho-medical professionals from two major ultra-orthodox communities in Israel. A thematic analysis was used to reveal key themes in the interviews. We found tensions between conflicting themes in the parenting, nutrition and physical activity domains, while the sleep domain illustrated cultural solution for a tension. By illuminating the perceptional components of lifestyle, the study contributes to better foundations of health promotion in closed-religious communities.

Risk and Protective Factors for Child Overweight/Obesity Among Low Socio-Economic Populations in Israel: A Cross Sectional Study

Background and Aims: Scientific evidence regarding protective factors that contribute to healthy weight in childhood is limited and is particularly scarce in lower socio-economic populations in different ethnic groups. This study aimed to assess the prevalence of biological, behavioral and psychosocial factors for child overweight/obesity in Jewish and Arab population groups in Israel, and to compare their associations with child overweight/obesity in the two groups. Methods: Children aged 5–6 years were randomly selected from 20 Mother and Child Health clinics in towns and villages of lowest socio-economic ranking in Northern Israel. Children and mothers were invited for a special “One Stop Shop–Preparation for School” visit which included growth measurements. Questionnaires were distributed to mothers for self-report on biological, SES, psychological and lifestyle factors. Perinatal and early nutritional data were retrieved from clinic records. Multivariate analyses using logistic regression models predicting child overweight/obesity were conducted separately for Jewish (N = 371) and Arab (N = 575) children. Results: Overweight/obesity (BMI ≥85th centile) rates were higher in Jewish (25%) than Arab (19%) children. In both Jewish and Arab groups, respectively, maternal BMI (OR = 1.10 [95%CI = 1.04, 1.17]; OR = 1.08 [95%CI = 1.04, 1.13]), and child birthweight (OR = 1.33 [95%CI = 1.04, 1.71]; OR = 1.39 [95%CI = 1.11, 1.73]) were significant risk factors for overweight/obesity, and maternal self-efficacy regarding childs lifestyle was significantly protective (OR = 0.49 [95%CI = 0.28, 0.85]; OR = 0.54 [95%CI = 0.34, 0.85]). Additionally, four other maternal psychological and child behaviors were significantly associated with overweight/obesity in the Jewish group and two child lifestyle behavior factors in the Arab group. Moreover, significant interactions indicating moderation effects were found only in the Jewish group: maternal education and maternal age moderated the effect of maternal BMI on child overweight/obesity. No other moderation of risk factors was found. Discussion: In this study of children from low SES families, protective factors contributed to healthy child weight alongside risk factors for overweight/obesity. They differed between the population groups, and fewer variables explained overweight/obesity in Arab children. Although further expansion of these findings is required they point at the relevance of protective factors, maternal self-efficacy in particular, for understanding childhood obesity in specific ethnic contexts and for planning culturally adapted prevention programs in disadvantaged populations.

Capsule commentary on Neff et al., Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians

T he influence of social inequalities on health and health care has been widely documented. The current challenge is determining how to train health professionals to reduce the impact of these inequalities within health care organizations as well as through direct patient care. The integration of health disparities and the social determinants of health into medical curricula has not yet been adequately addressed. While efforts are being made, most educational initiatives focus on the patient and not the societal constraints leading to disparities. The research by Neff and colleagues is an interesting and novel effort to address the effects of social structures such as economic, judicial or educational systems on health inequality, through the delivery of structural competency training to residents working with disadvantaged patients. The 3-hour training session aimed not only to raise awareness, but also to equip residents with the skills to respond to the downstream effects of societal structure. The session concluded with a discussion of practical and impractical strategies for dealing with the detrimental effects of social structure. Residents reported increased awareness of the effects of social structures on patients’ health, as well as distress at the lack of practical tools to address these issues. The authors ponder whether these residents might be more receptive to training because their residency already emphasizes care for the underserved, or whether the impact might be yet stronger in residencies with less of a focus. Research findings highlight the difficulties involved in educating health professionals on the social determinants of health and societal structures. Health care organizations are usually not the culprit in unwarranted differences between populations; as such, the role, scope and strategies health professional can adopt for reducing these unwarranted differences is still not clear. A recent literature review by the Institute of Medicine’s Global Forum on Innovation in Health Professional Education found that current educational efforts to address social determinants are delivered mostly in a classroom setting and lack practical strategies for how health professionals can address these differences. For medical educators, this study provokes thinking on how we may address the issues of social structures and health inequality, looking beyond the classroom or even clinical setting, and thinking of practical strategies to train future generations.

Leading Healthy Lives: Lifestyle Medicine for Medical Students

Background. Doctors have a special role in helping patients make lifestyle changes, and they are more credible and effective if they are role models. Yet few medical schools have incorporated lifestyle medicine into their curricula. We ascertained the influence of a lifestyle medicine curriculum during the first year of medical school. Methods. The curriculum, involving 140 students, consisted of one intensive day at medical school entry and 16 hours of teaching 8 months later. It addressed students’ own lifestyle choices and topics related to lifestyle medicine. A survey was delivered at the beginning and end of the academic year. Results. A total of 114 students completed the first survey and 64 the second. They rated the course highly for personal and professional value. At baseline, students exhibited lifestyle behaviors typical for young adults and showed an appreciation of the physician’s role in lifestyle change. However, over time they showed a significant reduction in quality of lifestyle, with increased stress, weight gain, and fast food consumption and less exercise. Conclusions. Although lifestyle medicine knowledge is valued by medical students, a 24-hour intensive lifestyle medicine curriculum delivered over 3 days appears to be ineffective in preventing worsening lifestyle behaviors over the course of the year. This is especially concerning as physicians are unlikely to provide effective guidance if they cannot sustain healthy behaviors themselves.